A phenomenological analysis of the subjective experience elicited by ibogaine in the context of a drug dependence treatment

EDUARDO EKMAN SCHENBERG, MARIA ANGÉLICA DE CASTRO COMIS, JOÃO FELIPE MOREL ALEXANDRE, LUÍS FERNANDO TÓFOLI, BRUNO DANIEL RASMUSSEN CHAVES, DARTIU XAVIER DA SILVEIRA

Journal of Psychedelic Studies, 2017, 1, (2), pp. 74–83

DOI: 10.1556/2054.01.2017.007

 

Objective : This report documents the phenomenology of the subjective experiences of 22 patients with substancerelated disorders who were involved in a treatment combining cognitive–behavioral therapy and hospital sessions with ibogaine in Brazil. Methods: Participants underwent a one-to-one semi structured interview exploring the subjective effects of ibogaine. We employed interpretative phenomenological analysis to identify relevant phenomenological categories, including physical sensations, perceptual (visual, auditory, and olfactory), emotional, cognitive, and spiritual. Participants also compared ibogaine with other drugs used in life, including psychedelics like ayahuasca, psilocybin mushrooms, and lysergic acid diethylamide. Results: The findings reveal that the subjective experience with ibogaine has similarities with other psychedelic substances, but also important differences. These include very strong and unpleasant physical effects as well as, at least in this patient population, a very difficult and challenging experience.

Conclusions : Overall, the descriptions involve heightened memory retrieval, specially related to drug abuse and the perception of one’s own future with or without drug use. Strong perceptual phenomena, especially dreamlike visions, were commonly reported. Based on Revonsuo’s evolutionary hypothesis for the function of dreams and of previous suggestions that ibogaine has oneiric properties, we suggest the subjective experience of drug-dependent patients elicited by ibogaine may be framed as simulations of threat and danger.

Keywords : ibogaine, dependence, phenomenology, oneiric, hallucinations

 

INTRODUCTION

Ibogaine is a naturally occurring monoterpene indole alkaloid studied since the 1960s as having important therapeutic properties in the treatment of drug dependence, specially reducing cravings to opioids (Alper, 2001; Alper, Lotsof, & Kaplan, 2008; Vastag, 2005; Winkelman, 2014). It has been additionally shown that ibogaine can also facilitate prolonged periods of abstinence in drug-dependent patients who were polyusers of alcohol, cannabis, cocaine, and crackcocaine but not opioids (Schenberg, de Castro Comis, Chaves, & da Silveira, 2014), further expanding the potential therapeutic applications of ibogaine, an important consideration given that there are important differences between opioid and psychostimulant dependence (Badiani, Belin, Epstein, Calu, & Shaham, 2011), with the latter currently lacking effective and approved pharmacological treatments (Karila et al., 2011; Nutt & Lingford-Hughes, 2009; Phillips, Epstein, & Preston, 2014; Shorter & Kosten, 2011). But despite considerable literature suggesting therapeutic applications of ibogaine in the treatment of drug addiction, there seems to be little information available in the scientific literature about its psychoactive effects per se. Ibogaine was first identified in the root bark of Tabernanthe iboga, a shrub whose root is used in shamanic rituals of the Bwiti among the Fang and the Mitsogho in Western Africa, mostly in present-day Gabon (Alper, 2001; Brown, 2013; Goutarel, Gollnhofer, & Sillans, 1993). After oral ingestion, it can induce long-lasting non-ordinary states of consciousness including alterations in perception, emotion, and cognition. Given the broad effects some controversy about its classification persists, with current suggestions including hallucinogen, psychedelic, or oneirogen properties (Alper & Lotsof, 2007). The current model of the subjective experience induced by ibogaine proposes three sequential phases lasting around 24 hr or more. The first, or acute phase, can last from 4 to 8 hr and is the most intense part of the experience where perceptual, emotional, cognitive, and physical aspects predominate. The second phase, termed intermediary or evaluative phase, can last from 8 to 20 hr, and consists of a period where the intensity of effects is considerably decreased, with the main characteristics being a heightened sensitivity to any sensory stimulation and a deepened capacity for introspection and reflection. The last phase, termed residual stimulation, can last from 1 to 3 days and is the phase where attention and consciousness returns to the ordinary state (Alper & Lotsof, 2007). The aim of the present report is to better and more comprehensively explore the subjective experiences induced by ibogaine, especially in the acute phase. Specifically, we relied on reports from patients with drug-related disorders who ingested ibogaine in a hospital in Brazil as part of their treatment. These reports were evaluated using interpretative phenomenological analysis.

(…)

2054.01.2017.007